Current management of anemia in oncology

Anemia in oncology is the most common hematological morbidity with incidence ranging from 30-90%. Cancer-related anemia is typically multifactorial; it can be secondary to cancer itself or cancer treatment or co-existent morbidities independent of cancer. Anemia has been recognized as an independent poor prognostic factor associated with poor survival and tumor control outcomes. Treatment of anemia in an oncology setting aims at correcting any reversible underlying cause and providing supportive therapy with erythropoietin stimulating agents(ESAs) + iron therapy or PRBC transfusion. Selection of treatment option relies on individualized risk assessment of each patient. Until recently, ESAs had been the most frequent agents used but evidence of increased mortality associated with ESAs in various randomized trials has led to restriction of their use outside the chemotherapy setting. PRBC transfusion provides almost immediate correction of anemia. However, concerns regarding tumor progression and poor survival outcomes associations with transfusions have been raised following various retrospective and few prospective studies. But, in the current scenario of restricted ESA use, increased demand of this finite source in oncology is much anticipated.